Purpose To evaluate the clinic application value of 4D computed tomography (CT) performed with a prototype 128-slice CT scanner in acute infarction caused by cerebral artery severe stenosis or occlusion.Methods Thirty-four patients with intracranial artery severe stenosis were scanned by 128-slice CT scanner.The volume CT perfusion (CTP) parameter maps of cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT),and time to peak (TTP) ware analyzed.Meanwhile cerebral CTA images were obtained.Results CTP was showed abnormal in Thirty-four patients.CBF decreased than contralateral side in the region of ischemic penumbra around the cerebral infarct (P>0.05).There were significant differences of CBV between affected side and contralateral side (P<0.05).TTP and MTT of affected side were significantly prolonged compared to contralateral side (P<0.05).The agreement between CTA and DSA was greater in the detection of cerebral artery severe stenosis or occlusion (kappa=0.888,P=0.039<0.05).Conclusion Comprehensive information of intracranial artery severe stenosis and hemodynamic changes in acute infarction could be achieved with the 4D-CTA protocol by 128-slice CT scanner.It has great value for clinical application.